小儿急性轮状病毒肠炎的电解质渗透压与阴离子间隙分析

Analysis on electrolyte and osmotic pressure and anion gap of acute rotavirus enteritis children

目的 探讨小儿急性轮状病毒肠炎的电解质、渗透压和阴离子间隙 (AG)的变化情况以及相互间的关系。方法 6 2例患儿均在治疗前作血清Na+ 、K+ 、Cl-、CO2 CP和渗透压的测定。AG按Na+ - (Cl-+HCO-3 )计算。所有患儿均采用ELISA方法检测大便轮状病毒抗原。结果 代谢性酸中毒 (简称代酸 )、血钠低于正常 (<135mmol/L)、高氯血症和低钾血症 ,分别为 87 1%、45 2、41 9%和 38 7%。酸中毒随脱水程度的加重而加重 (χ2 =10 47,P <0 0 0 5 )。渗透压以低渗为多 6 6 1% ,等渗次之 2 9% ,高渗仅 4 8%。低渗性脱水 34例 ,其血Na+ 均值为 132 0 3mmol/L ,但与总体均数相一致 (t=2 0 ,P >0 0 5 )。AG正常、增高和降低分别为 5 6 5 %、38 7%和 4 8% ,平均水平是 14 48± 5 39mmol/L。AG与血Na+ 呈正相关 ,AG水平随脱水程度的加重而升高 (t=2 872 ,P <0 0 1)且随脱水性质的加大而上升 (F =13 473,P <0 0 1)。临床诊断代酸 5 4例 ,其中高AG组2 3例 ,正常AG组 2 9例 ,低AG组 2例 ,三组代酸发生率无显著性差异 (χ2 =2 5 6 7,P >0 0 5 )。结论 电解质紊乱及酸碱失衡以低钠、低钾、高氯及代酸多见。渗透压以低渗为多 ,若以血钠来判断低渗压 ,建议以 <135mmol/L为宜。AG增高对代酸的诊断优于HCO-3 的降低。

Objective To study the changing state of electrolyte, osmotic pressure and anion gap (AG) as well as the relation among them in children with acute rotavirus enteritis .Methods Before treatment serum Na +、K +、Cl -、CO 2CP and osmotic pressure were detected in 62 patients .AG was calculated according to Na +-(Cl -+HCO - 3).Rotaviral antigens in faeces of all children were determined by ELISA method Results Metabolic acidosis,low serum sodium (<135 mmol/L),hyperchloremia and hypokalemia were 87 1%、45 2、41 9% and 38 7%,respectively .The degree of dehydration became severe and acidosis became serious (χ 2=10 47, P <0 005).Hypoosmotic pressure was most (66 1%),isosmotic pressure was secondary (29%),hypertonic pressure was only 4 8%.In the hypotonic dehydrations of 34 cases,the mean of the serum sodium which was 132.03 mmol/L was consistent in the total mean (t=2 0, P >0 05).Normal ,high and low AG were 56 5%、38 7% and 4 8%,separately .The mean of AG was 14 48±5 39 mmol/L .AG and Na + showed positive correlation .AG becoming high accompanied the degree of dehydration becoming serious (t=2 872, P <0 01) and the bigger the dehydration ,the higher the level of AG (F=13 473, P <0 01).In 54 metabolic acidoses diagnosed in clinic ,high,normal and low AG groups were 23,29 and 2 cases ,respectively ,the incidences of the metabolic acidoses showed no difference among the three group (χ 2=2 567, P >0 05)。Conclusions Low sodium,low potassium,higy chlorine and metabolic acidosis were most seen in electrolyte disorders and acid /base imbalances observed by us .The major osmotic pressures were hypotonic .If judging hypoosmotic pressure by serum sodium ,it is suggested that Na +<135 mmol/L be suitable .The rising AG was superior to the lowering HCO - 3 on the metabolic acidosis' diagnosis . [